Application For Copy Of Birth Or Death Record Form
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1Kendall County Clerk & Recorder
111 West Fox Street, Rm. 220
Yorkville, Illinois 60560
630 – 553 – 4104
APPLICATION FOR COPY OF BIRTH OR DEATH RECORD
PLEASE BE SURE THAT THE EVENT HAS TAKEN PLACE IN KENDALL COUNTY
Under Illinois State Law (410 ILCS 535 - Vital Records Act), only specific individuals have legal access to birth, death or
marriage certificates. The Kendall County Clerk’s Office will issue certificates only to authorized individuals. To do
otherwise is a violation of Illinois law. VITAL RECORDS ARE NOT CONSIDERED PUBLIC INFORMATION, NOR ARE
THEY SUBJECT TO THE FREEDOM OF INFORMATION ACT.
To obtain a Birth Record you must be:
•
Of legal age (18 years) if requesting your own certificate.
•
The mother of the child whose birth certificate is being requested.
•
The father of the child (if you are listed on the birth certificate).
•
A legal guardian, agent or representative with documentation to this.
•
Certificates of persons over age 75, who are living, will be released to authorized individuals only.
Fee:
The fee for a certified copy of a birth certificate is $10.00 for the first copy and $2.00 for each additional copy.
To obtain a Death Record you must be:
•
The informant listed on the Death Certificate OR the next of kin
•
Someone who has a personal or property right interest in the record.
Fee:
The fee for a certified copy of a death certificate is $12.00 for the first copy and $6.00 for each additional copy.
A SEARCH FEE PER DOCUMENT APPLIES IF THE DOCUMENT IS NOT FOUND.
YOU MUST PROVIDE PHOTO IDENTIFICATION TO RECEIVE ANY VITAL RECORD
MAIL-IN REQUESTS MUST PROVIDE PHOTOCOPY OF ID WHEN SUBMITTING APPLICATION
Please Note: This form may be downloaded & used for mail-in orders. It must be accompanied by the proper
documentation and payment in full by check or money order.
CERTIFICATE INFORMATION
DATE OF REQUEST____________________
NUMBER OF COPIES____________________
TYPE OF RECORD REQUESTED: _______BIRTH
_______DEATH
DATE OF EVENT___________________________
PLACE OF EVENT_________________________________
NAME ON RECORD____________________________________________________________________________
YOUR RELATIONSHIP TO NAME ON RECORD______________________________________________________
APPLICANT INFORMATION
NAME______________________________________________________________________________
ADDRESS__________________________________________________________________________
CITY, STATE & ZIP CODE______________________________________________________________
DAYTIME PHONE NUMBER____________________________________________________________
REASON FOR REQUEST______________________________________________________________
I affirm, under penalty of perjury, that the representations made on this application are true to the best of my knowledge and
belief.
SIGNATURE___________________________________________________________________________________
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